50-Plus Voters and the Health Care Law

Missourians debate the pros and cons of the Affordable Care Act

En Español |Some older Missourians worry that the Affordable Care Act is socialized medicine, as is practiced in Brazil and Norway, where universal health care is paid for by the government. (It's not. Insurance will still be provided by private companies.)

A 60-year-old Medicaid patient in St. Louis waves his health benefits card proudly, saying he's pleased the new law will provide such a card to everyone. (It won't. He's confusing Medicaid with universal health care.)

Missouri voters over 50 have strong opinions of the health care law. Yet most also acknowledge that they still don't completely understand what it means for them and the 14 percent of Missourians who are uninsured. And in a state where more than 70 percent of voters approved a largely symbolic ballot referendum barring the law's health insurance mandate, these issues have stirred particularly heated debate.

This November, Missourians may have the opportunity to vote on whether the state should be allowed to set up the law's health care exchanges without the express approval of voters.

The federal law requires everyone to have health insurance by 2014 — subsidies will help them do so — or pay a tax. It's President Obama's signature achievement. GOP contender Mitt Romney signed a similar law when he was Massachusetts governor but has pledged to undo "Obamacare'' on day one if he is elected.

Many Americans have trouble "separating the politics from the policy" regarding the controversial law, said Thomas McAuliffe, policy analyst for the nonpartisan Missouri Foundation for Health. "People like what's in the law. They just don't like the law itself," he said.

Shannon Lemp, 54, is among the huge class of skeptics. "I think of it as socialized medicine," said Lemp, an event planner married to an attorney. Lemp and some of her neighbors in the tony St. Louis suburb of Ladue worry that Americans will not be able to choose their own doctors, or that they will have to wait a long time for treatment of serious illnesses. "We don't really believe we'll be able to keep our own health insurance," she said.

Others feel a bit more sanguine about the health care law, especially if they have felt the law's early benefits, such as the closing of the "doughnut hole" in Medicare Part D prescription drug coverage. Bob Case, a 62-year-old self-employed St. Louis blues musician, likes the fact that the law allows him to keep his college-age son on his family insurance policy. "It's a big concern for all of us," Case said.

Mabel Barnes, 64, a housekeeper in downtown St. Louis, admitted she doesn't know the details of the law, but she's hoping that it could help her get cheaper health insurance than what she receives through her employer. Barnes is a fan of President Obama but wishes the administration had done more to inform people about how their lives would change under the new law. "I want to know — do I keep my insurance? Why didn't [Obama] explain it all before?'' Barnes said.

McAuliffe, the policy analyst, has been traversing Missouri, holding more than 160 informational events to explain the law to residents. And, he reports, older voters are curious, agitated and anxious — either exasperated over their neighbors' reluctance to sign on to something meant to provide health coverage to almost everyone, or leery of a law they say puts their private health in the hands of government bureaucrats.

"I don't see how it's a contentious issue if everybody is going to have some kind of insurance," said Evelyn Gillespie, 64, as she sparred with friends and colleagues at OASIS, a nonprofit group that operates health and learning programs for people over 50. African Americans such as herself are particularly at risk for poor or infrequent health care, added Gillespie, a retired health and physical education teacher who volunteers at OASIS. And the cost? "You pay for it no matter what way you go, through Medicare or taxes," she said.

Bob Kremer, 57, a retired UPS employee, said he's worried about cost and basic freedoms. "A lot of people don't want the government involved in everything," he said. Meanwhile, "the insurance companies will be in hog heaven," since the law creates so many new customers for them, he said. And Ann Eggebrecht, a retired, 66-year-old office manager, has some concerns about cost as well, noting her insurance deductibles are already high. "We can't pay for everybody to have everything," she said.

But, she added, with an eye on Election Day, "Let's see how it's going to play out."